The war on HIV in Florida: CDC director promotes plan to eradicate infections by 90 percent

Dr. Robert Redfield, director of the CDC, speaks with the Tallahassee Democrat about HIV treatment and how to stop the spread of the disease Tuesday, June 18, 2019. (Photo: Alicia Devine/Tallahassee Democrat)

For the last two days, Dr. Robert Redfield, the director of the Centers for Disease Control, has barnstormed Florida, meeting with state leaders and health officials to promote a new national plan to eradicate new cases of HIV over the next decade.

His Florida trip included meetings with Lt. Gov. Jeanette Núñez, seven county health directors, and Jackson Memorial Hospital researchers in Miami on Monday, and Gov. Ron DeSantis and state health officials in Tallahassee on Tuesday.

The initiative’s goal is to reduce HIV infections by 75 percent in five years and at least 90 percent in 10 years.

It will focus on where new HIV cases are highest — 48 urban counties, including seven in Florida, Washington, D.C. and San Juan, Puerto Rico. It also will focus on seven southern states with large rural populations infected with HIV.

“We want people to recognize that this is a once-in-a-generation opportunity for us to put science into action,” Redfield said in an exclusive meeting with the USA TODAY NETWORK - Florida. “This is a very pragmatic, measured goal to bring the outbreak in America to an end. It’s going to be complimented with significant resources to make that happen.”

President Trump has asked Congress for $291 million in the 2020 budget to finance the first year of the program.

Florida has consistently ranked among the top three states in the nation for newly diagnosed cases of HIV, according to CDC data. It has an estimated 115,000 residents infected with the disease, many of whom don’t even know they carry it.

In 2017, Florida had the second highest rate of new HIV cases in the nation, according to the CDC, at 22.9 per 100,000 right after Georgia. It had the highest number of newly diagnosed cases in 2016, concentrated in seven counties — Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach and Pinellas counties.

That’s consistent with national numbers. Some 1.2 million people are infected with HIV, and about 300,000 to 400,000 either don’t know they have it or have fallen out of treatment, Redfield said.

The 50 jurisdictions and seven states targeted in this multi-phase, 10-year program are responsible for over 50 percent of new infections that occurred nationally.

The number of new HIV infections has held steady at about 40,000 a year for the last five to seven years. If the federal government did nothing, the number of infected would grow by another 400,000 in 10 years. At a cost of $500,000 for a lifetime of HIV treatment per person, it would cost over $2.5 billion to treat all those additional people.

"We have a huge opportunity to end the outbreak and to avert substantial amount of future public costs," Redfield said. “We have the tools to bring the epidemic to an end."

Those tools include highly expensive anti-retroviral and pre-exposure prophylaxis drugs that can suppress the virus to allow people to live normal lives and lifespans without further spreading the virus, Redfield said.

The U.S. Preventive Services Task Force issued a recommendation last week to expand access to PrEP to require all non-grandfathered private health insurance plans to cover PrEP without cost-sharing no later than in the 2021 plan year, according to the Health Affairs blog. Without insurance, a 30-day supply of PrEP can cost close to $2,000, putting it out of the reach of many people infected with HIV, it said.

“The initiative has as its premise that we are going to ensure that everyone that has the HIV infection has access to treatment,” Redfield said. “We’re going to ensure that anyone that would benefit from pre-exposure prophylaxis will have access to that.”

The CDC received a donation of enough PrEP treatments for 200,000 people up to the next 10 years, he said.

Next year, one of the most important drugs, Truvada, will become generic.

“We continue to work to see if there are additional ways to make this more and more affordable,” Redfield said. “This initiative is developed in such a way that people will get treatment independent of their insurance status.”

When the program is launched, expect to see an increase in new diagnoses, Redfield said, because people who have been infected for years will finally be diagnosed.

That's because one of the biggest challenges in treating HIV is the stigma still associated with it. People don't want to get diagnosed, and when they do they don't want to go to clinics for treatment or go to their neighborhood drug store to fill their prescription, Redfield said.

“The truth is we could end this epidemic tomorrow if every single person living with HIV infection could get an effective treatment and get the virus suppressed,” he said. “There would be no need for HIV prevention because there would be no way to transmit. But the reality is we are going to do both.”

Contact Schweers at jschweers@gannett.com. Follow him on Twitter @jeffschweers.